At some restaurants and food stores in McAllen, Texas, every item offered is fried.Michael S. Williamson/The Washington Post

Blanca Salas of McAllen, Texas, is fighting diabetes as she tries to feed her family on $430 in monthly benefits through the Supplemental Nutrition Assistance Program, formerly known as food stamps.Michael S. Williamson/The Washington Post

By Eli SaslowThe Washington Post

MCALLEN, Texas -- They were already running late for a doctor's appointment, but first the Salas family hurried into their kitchen for another breakfast paid for by the federal government.

The 4-year-old grabbed a bag of cheddar-flavored potato chips and a granola bar. The 9-year-old filled a bowl with sugary cereal and then gulped down chocolate milk. Their mother, Blanca, arrived at the refrigerator and reached into the drawer where she stored the insulin needed to treat her diabetes. She filled a needle with fluid and injected it into her stomach with a practiced jab.

"Let's go," she told the children, rushing them out of the kitchen and into the car. "We can stop for snacks on our way home."

The family checkup had been scheduled at the insistence of a school nurse, who wanted the Salas family to address two concerns: They were suffering from both a shortage of nutritious food and a diet of excess -- paradoxical problems that have become increasingly interconnected in the United States, and especially in South Texas.

For almost a decade, Blanca had supported her five children by stretching $430 in monthly food stamp benefits, adding lard to thicken her refried beans and buying instant soup by the case at a nearby dollar store. She shopped for "quantity over quality," she said, aiming to fill a grocery cart for $100 or less.

But the cheap foods she could afford on the standard government allotment of about $1.50 per meal also tended to be among the least nutritious -- heavy in preservatives, fats, salt and refined sugar. Now Clarissa, her 13-year-old daughter, had a darkening ring around her neck that suggested early-onset diabetes from too much sugar. And Antonio, 9, was sharing dosages of his mother's cholesterol medication. Blanca herself was too sick to work, receiving disability payments at age 40 and testing her blood-sugar level twice each day to guard against the stroke doctors warned was forthcoming as a result of her diet.

She drove toward the doctor's office on the two-lane highways of South Texas, the flat horizon of brown dirt interrupted by palm trees and an occasional view of the steel fence that divides the United States from Mexico. Blanca's parents emigrated from Mexico in the 1950s to pick strawberries and cherries, and they often repeated an aphorism about the border fence. "On one side you're skinny. On the other you're fat," they said. Now millions more had crossed through the fence, both legally and illegally, making Hidalgo County one of the fastest-growing places in America.

"El Futuro" is what some residents had begun calling the area, and here the future was unfolding in a cycle of cascading extremes:

Hidalgo County has one of the highest poverty rates in the nation … which has led almost 40 percent of residents to enroll in the food-stamp program … which means a widespread reliance on cheap, processed foods … which results in rates of diabetes and obesity that double the national average … which fuels the country's highest per capita spending on health care.

This is what El Futuro looks like in the Rio Grande Valley: The country's hungriest region is also its most overweight, with 38.5 percent of the people obese. For one of the first times anywhere in the United States, children in South Texas have a projected life span that is a few years shorter than that of their parents.

It is a crisis at the heart of the Washington debate over food stamps, which now help support nearly 1 in 7 Americans. Has the massive growth of a government feeding program solved a problem, or created one? Is it enough for the government to help people buy food, or should it go further by also telling them what to eat?

Blanca walked her children into the doctor's office in the sprawling town of McAllen and they took turns stepping onto the scale: 110 pounds. Seventy-eight. Fifty-five. "Not perfect, but not so bad," the doctor said. Then a nurse handed him the children's blood work -- a series of alarming numbers that lately read more like averages in this part of Texas. Clarissa needed to watch her sugar, he said. Antonio needed to increase the dosage of his cholesterol medication.

"Can I still eat hot Cheetos?" Antonio asked. "Just one bag a day?"

"Not anymore," the doctor said.

"One a week?"

"No."

The doctor set down his chart and turned to face Blanca. He had 17 more appointments on his schedule for the day -- 17 more conversations like this one. The waiting room was filled with the children of Hidalgo County, 40 percent of them experiencing severe hunger at least once each month and 32 percent of them obese. His challenge was the same one that preoccupied so many in the Rio Grande Valley: How could families who had so little find ways to consume less?

"Either you address this now or it will be too late," he told Blanca. "I can give you medicine, but that's not the permanent solution."

There was a time when Terry Canales thought he knew the solution, and that solution could be accomplished through politics.

Canales, a 33-year-old Texas state representative, grew up outside McAllen, surrounded by the poverty and obesity he called "the double deaths" of Hidalgo County. He had waited in line at the area's ubiquitous drive-through convenience stores and watched people use their government Lone Star cards to purchase some of South Texas's most popular snacks, paying $1 for hot Cheetos smothered with cheese or $2 for a Mexican snow cone covered with gummy bears and chili powder. He had seen children use food stamps to buy Red Bull energy drinks by the case, and he had seen some of those same children waiting in line at the medical clinic near his house where 28 people had diabetes diagnosed every day.

"We are slowly killing ourselves," he concluded.

So, he took time off from his law practice in 2012 to run for office, spending $500,000 of his own money to win a job that pays $600 a month. He left his wife and three young children at home to spend each week at the Capitol in Austin, where he became one of several lawmakers across the country working to change what people can buy with food stamps.

Minnesota wanted to ban candy, New York City hoped to eliminate soft drinks and South Carolina wanted to rule out cookies and cakes. As a model, they heralded the U.S. Department of Agriculture's own WIC program, which subsidizes the purchases of only a few hundred essential foods such as milk, cheese and baby formula for young mothers and children under 5. But no state had yet persuaded the USDA, which prohibits using food stamps only to buy tobacco and alcohol, so Canales decided to start smallest of all.

Instead of trying to regulate the estimated $2 billion in junk-food purchases enabled each year by food stamps, he wrote a bill to ban the food-stamp purchase of only one product. That was energy drinks -- high in caffeine and higher in sugar, expensive and marketed to children despite offering little nutritional value.

"A no-brainer," he explained as he introduced the bill in a committee meeting last summer.

Then he yielded the microphone and waited for rebuttals. The first critic was one he had anticipated, a lobbyist for the Texas Beverage Association, which desperately wanted all of its drinks available for sale to the fastest-growing market in America: the food-stamp market, which has quadrupled from $20 billion to $80 billion in the past 12 years. Companies such as Coca-Cola, Kraft and Mars have spent more than $10 million in the past several years lobbying Congress to keep their products available to those using food stamps. "No clear standards exist for defining foods as good or bad," the lobbyist said.

But next came a litany of speakers Canales hadn't expected. They were Democrats who shared his ideals and equaled his devotion in the fight against poverty. At previous committee meetings on his other bills, many of them had lined up to speak on his behalf.

"Better not to micromanage other people's diets," said the director of an interfaith organization.

"Opposed," said the representative of a Texas food bank.

"Against," said the head of an anti-hunger group.

For more than half an hour, Canales listened to their concerns about his bill and another proposed by a lawmaker who wanted to eliminate candy and chips: Should government really be in the position of telling adults what to eat? And if so, who would be trusted to sort through the 40,000 items sold in a typical grocery store and divide healthy from unhealthy? If energy drinks were banned, why not also ban canned iced coffee that has twice the caffeine and triple the sugar? Or Sunny D fruit drink? Or Gatorade? Or fruit punch? And once every product had been rated and sorted, what if some grocery stores decided it was easier not to accept food stamps at all? Or what if food-stamp recipients felt too stigmatized to shop?

Wouldn't lawmakers be better off working to solve the problems of poverty rather than regulating them? How about funding programs for nutrition education, or encouraging more fresh produce in inner-city grocery stores, or building playgrounds and making streets safer so people would exercise? Why not focus on alleviating the stresses of poverty, which so many studies had linked to overeating?

"It is unrealistic to expect someone stretching their dollars to be highly worried and focused on nutritional content," one food policy analyst testified. "They just need to eat."

The committee meeting ended without a vote on Canales' proposal, and suddenly he, too, felt a little less sure. He did nothing to resurrect his bill over the next weeks, deciding instead to raise money for diabetes awareness and nutrition education.

"The more you learn in this job, the more complicated it gets to take a position," he told his district director one evening a few months after the committee meeting.

"What do you want to do about it, boss?" the district director asked.

"I don't ever want to pass a bill and end up regretting it," he said. "Let's teach people to make good choices and go from there."

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